LSU's Shreveport medical school has signed letters of intent with hospitals in northern and central Louisiana for future collaboration to put the institution on firmer financial footing and improve its impact on health care, though officials declined to provide the letters or name the potential partners.

The Times and its sister newspapers in the USA Today Network of Louisiana believe the documents are public records and have filed a freedom of information request with LSU to obtain and publish the letters of intent.

"(LSU Health Sciences Center-Shreveport) is exploring relationships with multiple regional hospitals, leveraging our respective resources to improve access to clinical care, medical education and research throughout North Louisiana," said Vice Chancellor Victor Yick in an electronic response to questions. "Letters of intent were signed to demonstrate good faith effort in the collaboration."

LSU Health Sciences Center-Shreveport Chancellor G.E. Ghali is traveling out of the country this week and was unavailable.

Hedgecock said Yick cited "confidentiality agreements" as the reason for not providing the letters of intent.

LSU already has a contract with Biomedical Research Foundation, which operates state safety net hospitals in Shreveport and Monroe, although the two have a fractious relationship that has spilled into courtroom battles.

"I haven't seen the letters of intent, but I look forward to learning more about it," said Biomedical Research Foundation Chairman Steve Skrivanos.

Expanding affiliations with more hospitals would be a similar model to the one LSU's medical school in New Orleans operates in southern Louisiana.

"We are creating a new business model based on relevant experiences from academic medical centers around the country, and directions provided by health care reform measures from the federal (Affordable Care Act) legislation," Yick wrote. "What we learn from our colleagues in New Orleans is that we can have a much more robust (graduate medical education) program by partnering with multiple hospitals to provide diversity in training experiences.

"We are reviewing and reinventing our business model to live within our own means in the long run," he wrote. "We are aggressively addressing both the revenues and expenses of our operations. We will work collaboratively with our existing hospital partner to fulfill our (cooperative endeavor agreement) obligations to serve our communities. It will take some time to go through the transformation and we appreciate the unwavering support from our legislators and governor in spite of the fiscal difficulties that our state is in."

He wrote the collaborations could generate funding for the medical school through faculty providing services to residents working at the hospitals.

"The relationship with the new hospital partners through the (letter of intent) process may result in (LSU Health Sciences Center-Shreveport) faculty providing clinical, teaching or supervisory services (to residents) at the partnership hospitals," Yick wrote. "(LSU Health Sciences Center-Shreveport) will negotiate Professional Services Agreements (PSA's) with those hospitals for those services.

Northwestern Louisiana lawmakers who are advocates for LSU Health Sciences Center-Shreveport said they are encouraged by the potential impact of expanded collaboration, but they expressed concern about transparency.

"It's troubling to me that LSU won't release the letters, but unfortunately it's been a pattern, at least with me personally as I've tried to get information in the past," said Rep. Cedric Glover, D-Shreveport.

"I knew there had been ongoing negotiations, but I wasn't aware they were completed," said Sen. Barrow Peacock, R-Bossier City. "I believe in transparency."

Still, both legislators are hopeful future affiliations with regional hospitals can solidify the financial stability of the medical school and elevate its impact.

"I believe such collaborations with multiple partners can be very good for the school as it has been in New Orleans," Peacock said.

"The LSU medical school is a critical component to our region's economy, quality of life and the overall health of our population," Glover said.

LSU''s Shreveport medical school has been reliant on state general fund appropriations to operate since former Gov. Bobby Jindal privatized the state's charity hospital system.

Last year the Legislature appropriated more than $30 million for the school to continue normal operations.

This year the Legislature first designated $26 million toward the school in a supplemental appropriations bill before the amount was eventually reduced to $4 million in the final version of the bill Gov. John Bel Edwards signed.

Following legislative passage of the bill, LSU President F. King Alexander and Edwards said the $4 million could be leveraged for much more with the state's Medicaid expansion to replenish the school. "It will just make us jump through a few hoops, but we'll work with (the Department of Health) to make it happen," Alexander said June 23.

Glover voted against the bill because he isn't convinced the funding for the medical school or the private partner operators of the safety net hospitals ($50.5 million) is adequate.

"I made some hard (tax) votes to fund the medical school and hospitals at a level they said was needed," Glover said. "If $4 million was enough it should have been discussed long before that final night. It seems dubious to me, and I have great concern."

Peacock said he agreed to the $4 million for the medical school after consulting with Ghali and Louisiana Department of Health officials.

"I'm comfortable because the people who are experts at DHH and the medical school said this can work," Peacock said. "I have to rely on the experts."

Yick said LSU will continue to explore avenues to strengthen the medical school.

"We are continuing to look for innovative ways to improve access to clinical care, provide robust and diversified opportunities to train our residents and fellows and support the governor's Medicaid expansion program," Yick wrote. "It will take some time to go through the transformation, and we are relying on the continuing support from our community leaders, legislators and governor during the transition period."

Greg Hilburn covers state politics for the USA TODAY Network of Louisiana. Follow him on Twitter @GregHilburn1